The Ductus Arteriosus Rarely Requires Treatment in Infants > 1000 Grams

Abstract

We sought to determine the rate of spontaneous closure of the ductus arteriosus (DA) in very-low-birth-weight infants. This prospective observational study included 65 infants whose birth weight (BW) < 1500 g. Echocardiograms were done on day of life (DOL) 3 and 7, weekly for the first month, and bimonthly until ligation, discharge, or death. Treatment was reserved for infants with heart failure, acute renal impairment, or those with significant persistent or escalating respiratory support. Chi-square tests, Student T tests, and logistic regression models were used to identify possible associations between spontaneous ductal closure by DOL 7 and predictor variables. Patterns of spontaneous DA closure over time were examined using Kaplan-Meier survival analysis. The DA closed spontaneously in 49% infants by DOL 7. Rates of spontaneous closure by DOL 7 differed significantly by BW strata: 67% for BW > 1000 g, 31% for BW <or= 1000 g ( P < 0.01). Ninety-seven percent of infants > 1000 g did not require intervention, and the DA closed spontaneously prior to discharge in 94%. In a logistic regression model, only BW > 1000 g and male gender were significantly associated with spontaneous closure by 1 week of life. The median time to spontaneous closure differed significantly between infants in the two BW strata: 7 days for > 1000 g versus 56 days for <or= 1000 g ( P < 0.001). Intervention for the patent DA in infants > 1000 g BW is rarely indicated. In infants <or= 1000 g BW, deferring treatment decisions until at least 1 week of life may avoid unnecessary treatment exposure.

Treatment of persistent patent ductus arteriosus in preterm infants: time to accept the null hypothesis?

“…131 Spontaneous closure rates, particularly after 7 days of age, may be underestimated, as the majority of infants included in these reports were treated by the second week after birth. In a prospective observational study of 65 very low birth weight (<1500 g) infants, Nemerofsky et al 132 found spontaneous ductal closure by 7 days of age in 31% of those with birth weights p1000 g and in 67% of those with birth weights >1000 g. For those with BWp1000 g, spontaneous closure without intervention occurred before discharge in 47% (at a median age of 56 days); one infant was treated with indomethacin in the first week and the remaining 16 had treatment initiated at a median age of 14 days. Among the larger infants (BW>1000 g), no intervention was required in 97% and the ductus spontaneously closed before discharge in 94% (at a median age of 7 days).…”

“…Pragmatism dictates incremental movement in that direction. Nemerofsky et al 132 have suggested an excellent initial strategy: refrain from treatment altogether in infants with birth weights >1000 g and defer treatment until at least the second week after birth in smaller infants. The available evidence indicates that this will substantially reduce the number of infants subjected to potential adverse effects of treatment without incurring an incremental risk of untoward long-term outcomes.…”

Prolonged persistent patent ductus arteriosus: potential perdurable anomalies in premature infants

“…[24][25][26][27][28] A second one is that, with time, an important number of PDA's close spontaneously. [29][30][31] The third one is that this clinical condition has a wide range of severity. There are many infants in whom PDA's have no clinical significance, whereas others may have severe ventricular insufficiency and pulmonary edema.…”

Can Treatment of Patent Ductus Arteriosus with Ibuprofen Compared to Supportive Management Affect Regional Brain Volume in Very Low Birth Weight Infants? A Pilot Study

“…However, there are no randomized controlled trials comparing the 3 different approaches, and there is an ongoing debate regarding the ideal treatment of PDA in preterm infants 9) . Because the rate of spontaneous ductus closure in infants weighing <1,000 g is very high, 35% by 6 days after birth, 67% by 7 days after birth, and 94% before hospital discharge, hemodynamically insignificant patent ductus arteriosus seldom requires treatment 10,11) . There fore, the treatment guidelines should be based on the clinical manifestations of hemodynamically significant PDA and tolerance in preterm infants, rather than focusing on the PDA itself.…”

“…There fore, the treatment guidelines should be based on the clinical manifestations of hemodynamically significant PDA and tolerance in preterm infants, rather than focusing on the PDA itself. Recently, supportive approach has become more common, and pharmacologic and surgical treatments are less commonly used 9,12) , but evidence supporting the treatment approaches is insufficient and the risks are not clear 9,10,13) . The brains of preterm infants achieve rapid growth during the premature period after birth, and are more vulnerable to various stresses 14,15) ; therefore, PDA still remains a risk factor for PVL, IVH, and white matter damage.…”